Educational Level and Length of Work Experience as Correlates of Adverse-Event Reporting and Patient-Safety...

Background/Objectives: Formal level of education and length of professional experience are widely thought to shape both how often nurses report adverse events and how safe they perceive their workplace to be for patients. Large multicentre data from Central and Eastern European secondary-care systems are scarce. This study examined whether educational level and length of work experience are associated with (a) the self-reported frequency of adverse-event reporting and (b) the perceived level of patient safety in a national sample of nurses working in Croatian general and county hospitals. Methods: We conducted a cross-sectional, multicentre survey in 2023 across all 22 general and county hospitals in the Republic of Croatia. A 99-item paper questionnaire-81 items distributed across six previously validated scales (Cronbach's α 0.730-0.951)-was distributed proportionally to the eligible nursing workforce (N = 6661). Of the 1657 questionnaires distributed, 1518 were returned fully completed (response rate 91.6%). Two outcomes were examined in parallel: self-reported frequency of adverse-event reporting in the past 12 months and global perceived level of patient safety on the respondent's ward. Group comparisons used Pearson's chi-square and Kruskal-Wallis H tests; effect sizes were estimated using the phi coefficient and Cramér's V. A multivariable logistic regression was additionally fitted to test whether the associations held after mutual adjustment. The study followed the STROBE reporting guidelines. Results: Educational level was associated with the frequency of adverse-event reporting (χ² = 32.54, df = 8, p < 0.001; Cramér's V = 0.10) and with safety perception (χ² = 16.07, df = 8, p = 0.041; V = 0.07). Length of total work experience was associated with reporting (χ² = 23.01, df = 12, p = 0.028; V = 0.07) and safety perception (χ² = 34.84, df = 12, p < 0.001; V = 0.09). After mutual adjustment, bachelor's (adjusted OR 1.41, 95% CI 1.10-1.81; p = 0.006) and master's or doctoral education (adjusted OR 1.82, 95% CI 1.27-2.62; p = 0.001) remained associated with active reporting relative to secondary-level qualification. A notable finding was that 930 nurses (61.3%) had not filed any adverse-event report in the past 12 months. Conclusions: Educational level and length of work experience are associated with both the reporting of adverse events and the perception of patient safety among Croatian hospital nurses, but the two characteristics relate to the outcomes in different ways. Higher education is associated with more frequent reporting and a more favourable view of patient safety. Length of experience shows a mid-career peak in reporting but a less favourable perception of safety in late-career nurses. Continued investment in formal nursing education, together with mid- and late-career retention strategies, may strengthen both reporting behaviour and the lived safety culture in Central and Eastern European secondary-care systems. The findings inform nursing leadership, continued education planning, and national patient-safety policy in Central and Eastern European secondary-care systems.